Phage therapy: an alternative approach to combating bacterial resistance

Abstract

Abstract Antimicrobial resistance is considered one of the greatest threats to global public health, being responsible for millions of deaths annually. Bacteria such as Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa have developed resistance to multiple classes of antibiotics, making treatment increasingly difficult. In this context, phage therapy has re-emerged as a promising alternative for the treatment of infections caused by multidrug-resistant bacteria. This study was conducted as a literature review based on articles indexed in PubMed, SciELO, and the National Library of Medicine (NLM) databases, considering publications from 2015 to 2025. Studies addressing the efficacy, advantages, limitations, and clinical applications of bacteriophages against multidrug-resistant bacteria were included. Clinical studies demonstrated favorable response rates of up to 66% and complete eradication in 42% of cases treated with personalized phage therapy. In vivo assays showed survival rates ranging from 80% to 100% in murine models infected with multidrug-resistant Acinetobacter baumannii. Recent studies also highlighted the efficacy of phage therapy in urinary tract infections and bacterial biofilm degradation, with reductions exceeding 90% in microbial viability in experimental models. Furthermore, biotechnological advances involving recombinant phages and the CRISPR-Cas system have expanded the therapeutic potential of phage therapy, particularly against biofilms and immune resistance mechanisms. Phage therapy represents an innovative and highly specific strategy for combating infections caused by multidrug-resistant bacteria due to its selective action and self-replication capacity. However, challenges related to immunogenicity, bacterial resistance to phages, and the lack of standardized regulatory frameworks still limit its large-scale clinical application, highlighting the need for further experimental and clinical studies.